We are currently doing 4 times/day for 3 day (hot moist compresses -(HMC)) after insertion of MST/Ultrasound placed PICCs because that is what the hospital did for PICC placement using the excaliber needles and antecubital placements. Is anyone else still doing this? Does anyone know of any articles regarding this?
Thanks in advance!
Andy
There was never any evidence that heat was required after PICC insertion with the old method. Now there are studies showing that the risk of phlebitis with upper arm insertion is less that AC insertions. So why do you need evidence to stop a procedure when there was never any strong evidence to support its use in the first place? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
for 24 hours after insertion. I agree that especially now that we don't ever place PICCs in the antecubital fossa and we're using MST, there is no need.
We stopped doing it because there was no literature stating prophylactic application of heat prevented phlebitis. There is evidence showing that heat reduces inflammation, so we'll recommend it if we think a phlebitis is beginning - often with good results.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Our outcome data showed that we had a low rate of phlebitis when doing the old method, so we never used heat routinely or prophylactically. We did use it when the infusion nurse found a PICC that was beginning to develope early stage mechanical phlebitis and it always resolved. I have never used heat application on all PICCs as a prophylactic purpose and do not know of any document that states it is a standard of care. Moving to the upper arm out of the AC has lower rates of complications so there is no need for the prophylactic treatment but it should be reserved for therapeutic treatment when necessary. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861